Wiki 88342 MUE limit of 3

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annettebec

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Swartz Creek, MI
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Medicare, BlueCross are denying any quantity over 3. However, we have 6 specimens with a stain performed on each specimen. We are reporting out 88342 x 6. Medicare and Blue CRoss are only paying 3. We have tried Line 1 88342 3 units, Line 2 88342-XS 1 unit, 88342-XS 1 unit, 88342-XS 1 unit and we have tried modifier 59. Is anyone else having this issue and if so how are you getting your claim paid. Any help appreciated.
 
I would suggest sending the actual path report to the insurance company to show justification for performing the testing.
 
We had the same problem we started billing one 88342 per line with a XS modifier. This seems to work most of the time, when it doesn't we send a coded pathology report showing the specimens and immune's. Hope this helps!
 
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